Provider Demographics
NPI:1477718823
Name:VELUSAMY, SATHYABALA (DMD)
Entity type:Individual
Prefix:DR
First Name:SATHYABALA
Middle Name:
Last Name:VELUSAMY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 CHAUNCY ST
Mailing Address - Street 2:APT# C-101
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1173
Mailing Address - Country:US
Mailing Address - Phone:857-272-8127
Mailing Address - Fax:
Practice Address - Street 1:252 ADELAIDE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1833
Practice Address - Country:US
Practice Address - Phone:857-272-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist